Elite hospital policy thrown into chaos by star ratings

22 Jul 04
The basis for awarding foundation status to high-performing NHS trusts was thrown into disarray this week after four of the 20 foundation trusts were stripped of their three-star ratings.

23 July 2004

The basis for awarding foundation status to high-performing NHS trusts was thrown into disarray this week after four of the 20 foundation trusts were stripped of their three-star ratings.

Moorfields, Addenbrooke's, Papworth and Peterborough foundation trusts were all demoted from the top flight and are languishing in the two star category after the 2003/04 ratings, the first from the Healthcare Commission, were published on July 21.

They now have until August 3 to submit recovery plans to the Independent Regulator of Foundation Trusts. Moorfields claimed it lost its third star because it had submitted incorrect data, but the other three were downgraded after failing to meet the key target on financial management.

John Appleby, chief economist at the King's Fund, said this raised 'serious questions' about the foundation trust selection process.

'They had been thoroughly assessed by the independent regulator as being financially sound. Either the star rating system is at fault or the independent regulator has reached a wrong assessment,' he said.

But the independent regulator stood by its assessment of the four trusts as being suitable for foundation status.

It said its financial assessment differed from that of the Healthcare Commission in that it reviewed future financial plans while the commission examined variance from annual plans. And the regulator poured cold water on suggestions that the downgraded trusts might lose their foundation status.

'We are satisfied that all foundation trusts have a sustainable and viable business plan. The loss of a star is not, of itself, a breach of its terms of authorisation,' a spokesman said.

But Appleby said the shortcomings of the star ratings regime were reinforced by the demotion of 11 of the 31 candidate foundation trusts, which all lost the third star needed to qualify.

These trusts' ambitions to become foundations have been killed off in the medium term, since none will now qualify before the February 2005 cut-off point, after which a moratorium will be imposed until a review has been completed.

'It seems clear that the rating system is too volatile to represent a proper assessment of NHS hospital performance,' Appleby said.

Overall, the star ratings show an improvement, with 24% of trusts attaining three stars compared with 22% last year, while 6% had zero stars (7% last year).

Healthcare Commission chair Sir Ian Kennedy conceded that the ratings system was imperfect and said it would be reformed in time for 2005/06. 'The commission is developing a new approach to the assessment of NHS bodies, which will allow a broader, richer picture of performance to be presented each year,' he added.

Following publication of the 2003/04 ratings, Health Secretary John Reid confirmed the number of national targets would be cut from 62 to 20 from April next year.

The new targets include year-on-year reductions in MRSA or 'superbug' levels and an 18-week maximum wait by 2008.

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